Parkinson’s patients can breathe a sigh of relief

New research at the University of Groningen offers hope to patients with Parkinson’s disease. Researchers from the Department of Pharmaceutical Technology and Biopharmacy and the Martini Hospital are developing a drug preparation that can be inhaled. Patients suffering from what is known as an ‘off-period’ (cramps throughout body) are expected to recover much faster with this innovation. A patient study will begin in April into the effectiveness of this new form of administration.

When a Parkinson’s patient experiences an off-period, the muscle that separates the stomach from the small intestine (the pylorus) cramps. This means that tablets containing the anti-Parkinson’s drug levodopa remain in the stomach, while the body can only absorb this medication in the intestines. Only if the pylorus spontaneously relaxes after a longer period of time does the drug enter the patient’s bloodstream – but then the full dose is absorbed in one go. The dose may then be too high, which can cause serious side effects. It thus takes a long time before the patient starts to feel better.

The research group of Professor of Pharmaceutical Technology and Biopharmacy Erik Frijlink has come up with a solution: administer levodopa with an inhaler. PhD student Marianne Luinstra is working in Frijlink’s group on levodopa administration through a Twincer. This small disposable inhaler, which now is mainly used to administer antibiotics to the lungs, was conceived and developed by Frijlink and his colleague Anne de Boer.

The advantages of inhalation are great when compared with tablets. The drug works much faster, because it does not need to travel to the intestine first. The levodopa thus circumvents the obstruction of the pylorus. As the intestine and the liver normally break down a large part of the drug, administration through the lungs means less levodopa is needed for the required effect. ‘It makes a big difference for a patient whether he has to lie in bed with cramps for one to one and a half hours or whether he can walk around again after 20 minutes. A huge difference’, says Frijlink.

A clinical study will start in April, funded by the Netherlands Parkinson’s Association. In this study, the Twincer will be used to administer levodopa through the lungs of Parkinson’s patients who are experiencing an off-period, and Luinstra will then measure the amount of the drug in their blood. This will show how much levodopa the body absorbs through the lungs and thus how effective this form of administration is. ‘We have high hopes’, says Frijlink. ‘We already know from earlier animal studies that levodopa can be absorbed into the body through the lungs.’

New pharmaceutical products are often very expensive, but using the Twincer to treat off-periods is no more expensive and probably even cheaper than the existing alternative. ‘Patients with very frequent and very severe off-periods are now given a levodopa pump’, says Frijlink. This administers the drug directly to the small intestine. Alongside the cost, another disadvantage is that this is a very intensive and inconvenient treatment. Inhalation of levodopa seems to be a good alternative: safe, efficient and easy for patients to use themselves. It will still take some years before this new form of administration becomes available for patients.

Alongside its uses for antibiotics and Parkinson’s, the Twincer can also be used to treat multidrug-resistant tuberculosis and to administer pain medication. These are but a few examples. ‘The Twincer could be very interesting for many other medical indications’, says Frijlink. Inhalation of medication could prove most important to the future of pharmacotherapy.

Text: Scarlett Braddock and Teyler Kroon. This article was written as a placement assignment for the Bachelor’s course unit Introduction to Teaching and Communication at the Faculty of Mathematics and Natural Sciences.